The Role of Chemotherapy in Today’s mCRPC Landscape

Chemotherapy remains a cornerstone therapy in metastatic castration-resistant prostate cancer (mCRPC) despite the emergence of multiple novel agents including ARPIs, PARP inhibitors, radiopharmaceuticals, and targeted therapies. The discussion emphasizes that chemotherapy's role has evolved but not diminished in clinical practice.

When considering cabazitaxel specifically, patient and disease characteristics are critical factors in sequencing decisions. Key considerations include prior lines of therapy received and real-world treatment patterns observed across different practice settings. The discussion highlights where chemotherapy fits relative to ARPIs, PARP inhibitors, and Pluvicto (lutetium Lu 177 viosotide) in the treatment algorithm.

Several thematic areas were explored regarding chemotherapy's continued relevance:

Mechanisms of Action: The unique mechanisms by which chemotherapy agents work distinguish them from other mCRPC therapies, contributing to their ongoing utility.

Clinical Relevance: Despite newer options, chemotherapy maintains an important role in the treatment paradigm for appropriately selected patients.

Disease Volume Considerations: The distinction between high-volume and low-volume disease impacts treatment selection, with chemotherapy playing different roles depending on disease burden.

Docetaxel in HSPC: The use of docetaxel earlier in the disease course—specifically in hormone-sensitive prostate cancer (HSPC)—influences later treatment decisions in the mCRPC setting.

The overall message underscores that chemotherapy has adapted to the evolving landscape rather than being displaced by it, with thoughtful patient selection and sequencing being essential to optimize outcomes in mCRPC management.